Liposuction 101

Liposuction is a method of body sculpting, body contouring or "spot-reduction" that involves the removal of excess fat from specific areas of the body. Liposuction can be done virtually anywhere on the body, including the abdomen, hips, buttocks, back, thighs, knees, calves, ankles and upper arms. In addition, facial liposuction is often performed to address the jowls, cheeks and neck.

Localized fat deposits may be inherited and typically do not respond to dieting or exercise. Liposuction is often the only way to remove them.

Liposuction is also referred to as lipoplasty, suction-assisted lipectomy, ultrasound-assistedliposuction or lipoplasty, laser-assisted liposuction or lipoplasty, power-assisted liposuction or lipoplasty, and water-assisted liposuction or lipoplasty.

Liposuction can be done alone or with other plastic surgery procedures such as breast reduction or tummy tuck (abdominoplasty). It can be performed on several areas of the body at once. Sometimes, liposuction is performed as the first step in a fat transfer procedure such as the Brazilian butt lift, fat grafting to the breast or a stem cell facelift. In these cases, fat is removed via liposuction, processed and then re-injected into another area of the body where it is in short supply.

How Liposuction Is Performed

Step One: Marking your territory. Using a magic marker, your surgeon will literally mark the areas of your body where he or she will remove unwanted fat.

Step Two: Anesthesia. Liposuction is typically performed under general anesthesia, but in some cases local anesthesia may be used. Other options include intravenous sedation or epidural block. The decision involves both you and your doctor and should take into account the nature and extent of the liposuction.

Step Three: Wetting solution. Wetting solutions are used to minimize blood loss and increase the safety of liposuction. They are infused into the area before fat is removed. The fluid contains saline (salt water), epinephrine (which constricts blood vessels to minimize any blood loss) and a local anesthetic.

Various types of wetting solutions are used in liposuction. The main difference between them is the amount of fluid used.

The "dry" technique. Before wetting solutions came along, surgeons went in dry. This resulted in blood loss and bruising. In fact, about 45 percent of what was suctioned out was blood (not fat), so the dry technique has fallen out of favor.

The "wet" technique. This technique involves the infusion of 100 to 300 milliliters of fluid (with or without epinephrine) into each treatment site. With the wet technique, 20 to 25 percent of what is suctioned out is blood.

The "super-wet" technique. The super-wet technique involves the infusion of greater amounts of fluid than with the wet technique. It involves a 1:1 or 1:1.5 ratio, which means that the amount of fluid is approximately equal to the amount of fat to be removed. Less than 1 percent of what is suctioned out is blood with this technique.

The tumescent technique. This involves even more fluid than is used in the super-wet technique. The surgeon will infuse three to six times as much fluid as the volume of the aspirate (fat, fluid and blood content) to be removed. Proponents say the tumescent technique swells the tissues, which aids in fat removal; but detractors say it interferes with the surgeon's ability to sculpt. Opponents also claim the technique is unsafe because of potential fluid overload and an overdose of anesthetic.

What Is a Cannula?

A cannula is a long, hollow instrument that is connected to the fat-suctioning device used during liposuction. When inserted through incisions in the skin, it enables the plastic surgeon to suction out the fat.

Today, cannulas are about 3 millimeters or finer in diameter. In the past, cannulas were as large as 10 to 12 millimeters in diameter. The smaller diameter means less trauma to surrounding tissues and blood vessels.

Step Four: Fat removal. There are many different ways to vacuum out the fat during liposuction.

Traditional suction-assisted liposuction. This involves inserting a cannula (a long, thin tube) through a tiny incision to vacuum the fat cells. The surgeon moves the cannula back and forth through the fat layer to break up, and then suction out, the excess fat.

Ultrasound-assisted liposuction. During this procedure the surgeon inserts a special cannula through small "access" incisions. The cannula emits sound waves to help break up the fat, making it easier to vacuum. Vaser-assisted liposuction is the third-generation version of ultrasound assisted liposuction technology. The cannula used for Vaser-assisted liposuction emits gentler sound waves to break up and then remove fat.

Power-assisted liposuction. This procedure uses a motorized cannula to break up fatty tissue that will then be vacuumed out. It is inserted through tiny incisions.

Laser-assisted liposuction. This involves a small incision and the insertion of a laser fiber probe that produces a burst of energy to liquefy the fat before it is removed. (Two of the brand names you may have heard about are SmartLipo and CoolLipo.) Proponents say that laser liposuction is the latest and greatest and may also tighten skin. But detractors say it adds nothing to the results of liposuction except for expense.

Body-jet liposuction. Using a thin, fan-shaped jet that pulsates water, your surgeon loosens fat cells from connective tissue while simultaneously vacuuming them out. It is sometimes called water-jet assisted liposuction or water-assisted liposuction. Other liposuction techniques destroy or break apart the fat cells before suctioning them out of the body, but the water-assisted technique may loosen them first. As a result, water-assisted liposuction may be less traumatic than traditional liposuction methods.

Putting It All Together

Based on your surgeon's experience and expertise and your particular case, he or she will choose the appropriate anesthetic, wetting solution and liposuction technique.

The time in surgery varies, depending on the size of the area being treated. It can span from 30 minutes to five hours. If you choose to have multiple areas treated at once, the procedure will take longer.

Who Is a Candidate for Liposuction?

The first step toward determining your candidacy for liposuction is a consultation with a board-certified plastic surgeon.

During this appointment or series of appointments, the plastic surgeon should take a thorough medical history. He or she will also talk with you about your expectations to make sure they are realistic.

Ideal candidates for liposuction are men and women of relatively normal weight with isolated pockets of fat that do not respond to diet and exercise.

You should have a firm and elastic skin tone and excessive fatty deposits in certain body areas. Liposuction removes fat, not loose skin.

Age is not a deciding factor, but many older people have less-flexible skin and may not get optimal results from liposuction.

Newer, non-invasive body contouring alternatives such as the two Zs  Zeltiq CoolSculpting and the Zerona laser  may be options for removing smaller pockets of fat such as love handles, muffin tops or Cesarean section bulges. Ask your doctor which treatment or combination of treatments makes the most sense for you.

Preparing for Liposuction

Your surgeon will give you a list of instructions on what to do and what not to do in the days before your liposuction procedure. This may include guidelines on eating and drinking. He or she will also discuss the importance of quitting smoking at least 30 days before liposuction. Smoking greatly increases the risks of any surgery.

Certain medications, such as aspirin and nonsteroidal anti-inflammatory drugs, may promote bleeding and should be discontinued before surgery. Never stop taking prescribed medications without first talking with your surgeon and the doctor who prescribed them.

What to Expect After Liposuction

The suctioned areas will be swollen and uncomfortable for several days after liposuction. In some cases, the small incisions are left open temporarily during liposuction recovery so that fluids and residual fatty deposits can empty through inserted drains. Your surgeon may prescribe an antibiotic to reduce the risk of infection.

Usually the treated area is wrapped with an elastic bandage. Support hosiery may be worn over this to help control swelling and bruising. Your surgeon may want you to wear the bandage and/or support garment for several days or weeks.

Walking soon after your surgery will decrease the risk of developing potentially fatal blood clots that can occur from long periods of being sedentary. You will be allowed to return to work or your normal activities in a few days. Strenuous activity, however, is a no-no for at least three weeks.

Be patient. The final results may not be evident for up to six months, but they are permanent (assuming that your weight remains stable). Depending on how gently the procedure was performed, you may see some preliminary results in as early as one week.

Liposuction Risks

All surgeries have risks, and liposuction is no exception. They include:

Infection

Fluid imbalance. Your surgeon may inject large amounts of fluids during liposuction. This can result in a fluid imbalance, which can lead to heart problems, excess fluid in the lungs or kidney problems as your kidneys try to maintain fluid balance.

Shock

Blood clots in the lung (pulmonary emboli)

Hematoma (a collection of blood in the areas suctioned that will likely clot)

Temporary numbness or discoloration in the treated area

Asymmetry, dimpling, wrinkling, unevenness and surface irregularities over the treated area

Perforation wounds in surrounding tissue or organs

Anesthesia reactions

Swelling

Burns (from ultrasound-assisted and laser-assisted liposuction)

Death

The vulnerability to liposuction risk is higher in people with any underlying medical conditions such as heart or lung disease, poor circulation or diabetes. These factors should all be addressed during your initial consultation with a board-certified plastic surgeon. Start your search for the right doctor right now.

Liposuction Cost

The average cost of liposuction performed on one area of the body is up to $4,000; in three areas it is $6,000 to $8,000; and in five areas it is $8,000 to $11,000. Liposuction cost is higher for larger body areas.

As a general rule, health insurance companies do not cover liposuction.

About the Reviewer of This Article

Peter Bela Fodor, MD, FACS, of Los Angeles, is an internationally recognized leader in the field of aesthetic plastic surgery and is highly respected by the profession as a surgeon, teacher and author. Dr. Fodor is associate clinical professor of plastic surgery at UCLA Medical Center. He lectures and performs live surgical demonstrations nationally and internationally.

After graduating from the University of Wisconsin Medical School, Dr. Peter Fodor completed his general surgery residency at New York's Columbia University and his plastic surgery residency at St. Luke's  Roosevelt Hospital. Dr. Fodor maintains hospital staff privileges at UCLA Medical Center, Century City Doctors Hospital and Olympia Hospital, all in Los Angeles, as well as at St. John's Hospital in Santa Monica, Calif. He is board-certified by both the American Board of Surgery and the American Board of Plastic Surgery.

Source: FDA website."What Are the Risks or Complications Associated with Liposuction?"

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